Closing the Information Gap on International Surrogacy

Beth G. had eight miscarriages before she and her partner considered in vitro fertilization (IVF). The couple also discussed adoption, but they ultimately opted for a surrogate in India. Beth and her partner visited Mumbai before signing on and felt that the gestational mothers in their agency were well cared for and decently compensated. But what did they really know about the practice of cross-border surrogacy?

In order to help close the information gap that exists around both cross-border surrogacy and commercial egg retrieval (from egg “donors”), the MacArthur Foundation recently awarded the women’s health advocacy group Our Bodies Ourselves (OBOS) and the Center for Genetics and Society (CGS) a two-year, $200,000 grant to support the collaborating organizations’ joint efforts to bring a human rights and social justice perspective to these two assisted reproductive technologies (ART) and to the rapidly growing industry they have spawned. Most countries prohibit commercial surrogacy, but in nations where it is allowed, policies vary greatly. India is the most popular destination, but prospective parents seek paid surrogates in a number of countries, including Mexico, Thailand, Ukraine, and the United States.

CGS, which works “to encourage responsible uses and effective societal governance of human genetic and reproductive technologies and other emerging technologies,” will interview egg providers and update its wiki-style compendium of various country-level policies on egg retrieval and surrogacy. It will also work with selected scholars on these projects.

“Cross-border surrogacy raises thorny questions, especially for feminists,” says Marcy Darnovsky, executive director of CGS. “Some people look at women selling their eggs or reproductive capacity as an individual right within the context of wage labor. Others see these practices as deepening gender and class inequalities in a not-so-free market. We will bring sorely lacking empirical evidence to this debate from a human rights perspective.”

Our Bodies Ourselves, in collaboration with key partners domestically and throughout their wide international network, will develop a web-based resource for prospective parents considering or already engaged in a cross-border surrogacy arrangement but possibly unaware of the troubling conditions for the gestational mothers they hire. Their work will provide evidence-based information on the nature, safety, ethics, and impact of cross-border surrogacy to counter the plethora of industry-sponsored information currently available.

“Most of the information available in the mainstream fails to paint a complete picture,” says OBOS’s Ayesha Chatterjee. “With faceless images of pregnant bellies, the narratives of gestational mothers remain untold. Convenience, concierge-like services, and various packages geared to attract intended parents in a competitive market are what is emphasized.”

Both CGS and OBOS support a wide range of ARTs, including surrogacy, as a reproductive choice, but they are deeply concerned by gaps in evidence-based information to facilitate well-informed decision-making within rapidly growing, mostly unregulated markets.

In a recent and revealing OBOS paper on cross-border surrogacy, Chatterjee and Sally Whelan wrote: “Often gestational mothers live in communities where cultural beliefs and systemic institutional oppression/marginalization make it hard for them to achieve financial independence and security. In India, for example, many gestational mothers are poor and have little social mobility. These factors create a power imbalance that makes it impossible for them to negotiate fair ‘work’ conditions within surrogacy arrangements. It allows those in positions of power (recruiting agents, fertility clinics, etc.) to get away with a range of exploitive practices.”

These practices include a lack of informed consent (since many women can’t read documents they are made to sign), minimal compensation and unfair payment schedules, isolation from family and restricted movement outside of surrogacy “residences,” constant monitoring, high-risk medical procedures, and unnecessary C-sections to accommodate traveling parents. Post-partum medical care may be poor or lacking altogether, and should problems occur, there is no life or disability insurance.

As for cases in which an intended parent’s egg is not used, “egg providers must undergo an intensive and risky process using hormones that have multiple short- and long-term effects,” OBOS points out. “Similar to gestational mothers, many egg providers receive minimal and sub-standard information about the health risks and they are often provided with little to no follow-up care.”

The work of CGS and OBOS will make available this kind of little-known or under-reported information, thereby illuminating the human rights and social justice issues inherent in surrogacy and egg retrieval.

In its 2012 report “Birthing a Market: A Study on Commercial Surrogacy,” Sama-Resource Group for Women and Health New Delhi shed light on the situation in India. Citing “an explosion of fertility services that promise a cure for the allegedly increasing rates of infertility,” Sama says the Indian fertility industry, estimated to be worth more than 400 million U.S. dollars, is proliferating rapidly despite the absence of regulatory or monitoring mechanisms.

“Commercial surrogacy is often portrayed as a win-win situation,” the Sama report notes. It is positioned as giving “desperate and infertile” parents a child while providing poor surrogate women with much-needed income. But “in the face of growing globalization of capital and shrinking local avenues for jobs and resources, women from marginalized communities and regions find themselves more impoverished, powerless, and vulnerable.”

Feminists are among the many diverse voices weighing in on surrogacy and egg retrieval. Some question health implications and raise issues about the broader effects on women’s lives, marriage, and parenthood. Others think the “patriarchal ideology of motherhood,” in the words of Sama, puts too much focus on biology, while still others argue that the most significant issue is the need to make all reproductive health technologies safer. But despite differences of opinion or emphasis, there is consensus that more needs to be known about ARTs and their impact on the personal, social, political, and economic lives of those that use them.

The work enabled by the MacArthur Foundation grant will provide an opportunity for OBOS and CGS to provide unbiased information in the face of lagging government oversight, media sensationalizing, and society’s lack of knowledge about the implications of assisted reproductive technologies. It will draw attention to the women on whose backs the industry continues to thrive, bringing much-needed information into the mainstream and helping to pave the way for, as Chatterjee and Whelan point out, “a real win-win for everyone.”

The views expressed in this commentary are those of the author alone and do not represent WMC. WMC is a 501(c)(3) organization and does not endorse candidates.

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